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INDUS TMfNT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> INDUSTRY, DIVISION <br /> LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 <br /> P.O. BOX 7969 <br /> HUMAN RELATIONS <br /> (ILHR 83.0911) & Chapter 145) <br /> LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: OT NO.:BLK.NO.: SUBDIVISION NAME: <br /> '/ E y /T N/R 16E (orM32 A P1 A)Es <br /> COUNTY: AILIN ADDRESS: <br /> 3ORMOT I Foyg 5a5okf-s 6 I HP. <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS.: COMMER IAL DESCRIPTION: PERCOLAT ION TESTS: <br /> Residence I �I ®New ❑Replace I C' _ ECj /r - pQ <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> ONVENTIONAL: MOUND: IN-GROUNI}PRESSURE: S STEM-IN-FILL OLOING TANK:R ECOMMENDED SYSTEM:(optional) <br /> NS ❑U ®S ❑U ®S ❑U EIS LUAU EIS ®U Copy- <br /> If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the <br /> under s. ILHR 83.0915)1b),indicate: Floodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTALP H TO GROUN DWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEVATION OBSERVED I EST.HIGHEST— TO BEDROCK IF OBSERVED SEE ASBRV.ON BACK.) <br /> B- 1 72 1'5-9 NOAJE > '7 0- 531 Ms S- 47 1W M5 Ly Z_- �22- <br /> B_ Z <br /> BZ (I 91.7II t1 O- S131m5S " 1467j)JMS (o - 77-- Y,rS <br /> B-3 II I6- C> It q O' b & M5 $-NvMS R„'IS <br /> u I II <br /> B 9911 O" S IMS 1Z +.1 <br /> BS () 900.9 11 II qnE AS g- 3 <br /> B- <br /> PERCOLATION TESTS <br /> EST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. p ql D1 P RI D PERINCH <br /> P- I 2 5 */ ''3' 3 <br /> P- Z 2`1 No S is 3/ 3 <br /> P- <br /> P- <br /> P- <br /> PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- <br /> zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent <br /> of land slope. <br /> SYSTEM ELEVATION % -7 <br /> RIUr'R- SCA Lt .I" = `lQr UNLESS Wo'(ED _ ;.a <br /> A►BM 100 0 1)1L iQ 2� Rk;P 0Ax— <br /> Ibo' ,G�t�ar � TN <br /> PRoPOn�n <br /> 0 l `4 <br /> 3 . <br /> , <br /> n <br /> Gt ?A > Q' RZOM 5Vrf <br /> 14-4 LOT 1,105 yb I ' <br /> I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin <br /> Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. <br /> NAME print ITESTS WERE COMPLETED ON- <br /> 1 Lil o Pk RNs '7- / s- SS <br /> ADDRESS: CERTIFICATION NUMBER: PHONE N MB ER(optional): <br /> � <br /> 16135-mx w I o - - <br /> CST SIGNATURE. <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHRSBDE395(R. 10/83) -OVER - <br />